Download HR 676 - Physicians for a National Health Program

HR 676
Expanded and Improved Medicare for All
MARGARET RUSSELL
SECOND YEAR MEDICAL STUDENT
NORTHWESTERN UNIVERSITY FEINBERG
SCHOOL OF MEDICINE
Expanded and Improved Medicare for All
 Expanded to include all individuals residing in the
United States
 Improved by:
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Eliminating Premiums, Copays, and Out-of-Pocket Expenses
Completely covering all necessary care for all beneficiaries
including long-term care.
Reforming payment systems to encourage accountable care
and equitable compensation for physicians and institutions.
Allowing for planned expansions of healthcare infrastructure
based on community need rather than profitability.
Eligibility and Benefits
 Who would be covered?
 “All individuals residing in the United States (including any
territory of the United States)”
 Individuals and families would fill out a program application
when they see a healthcare provider.
 A payment system will be established for visitors from other
countries seeking pre-meditated non-emergency surgical care.
Covered Benefits Include At Least
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Primary Care and Prevention
Approved Dietary and Nutrition
Therapies
Inpatient Care
Outpatient Care
Emergency Care
Prescription Drugs
Durable Medical Equipment
Long-Term Care
Palliative Care
Mental Health Services
Substance Abuse Treatment
Services
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Chiropractic Services, not
including electrical stimulation
The full scope of dental services
including periodontics, oral
surgery, and endodontic, but
not including cosmetic
dentistry
Basic Vision Care and Vision
Correction (other than laser
correction for cosmetic
purposes)
Hearing Services, Including
Hearing Aids
Podiatric Care
Eligibility and Benefits
 Can patients choose their health care providers?
 “Benefits will be available through any licensed health care
clinician anywhere in the United States that is legally qualified
to provide the benefits.”
 What will patients be charged for covered services?
 “No deductibles, copayments, coinsurance, or other costsharing shall be imposed with respect to covered benefits”
 The bottom line:
 There will be no financial or administrative barriers preventing
patients from receiving care from the physician of their choice.
Qualification of Participating Providers
 Who will be the participating providers?
 Public or Non-Profit Healthcare Institutions
 Private physicians, private clinics, and private healthcare
providers who are not investor-owned.
 Health Maintenance Organizations (HMOs) that are nonprofit, deliver care in their own facilities, and employ clinicians
on a salaried basis.
 For-Profit entities wishing to participate will have to convert to
non-profit status.
Prohibition Against Duplicating Coverage
 It will be unlawful for any
private health insurer to sell
health insurance coverage
duplicating the benefits
provided under the Act.
 Insurance coverage may be sold
for additional benefits not
covered by the act.
How will providers be paid?
 Institutional Providers will receive a monthly lump
sum based on their annual budget.
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“The budget shall be negotiated annually, based on past
expenditures, projected changes in levels of service, wages and
input, costs, a providers maximum capacity to provide care,
and proposed new and innovative programs”
How will individual providers be paid?
 1. Fee for Service
 Physicians will submit bills to the regional directors and will
receive interest on any balance not paid within 30 days.
 2. Salaries within Institutions Receiving Global
Budgets
 3. Salaries within Capitated Groups
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HMO requirement: Physicians will be reimbursed based on a
salary and my not receive financial incentives tied to
utilization.
Budgets for other Services
 Long Term Care
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Regional budgets will include long term care including in-home,
nursing home, and community-based care.
 Mental Health Services
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Licensed mental health clinicians will be paid in the same manner as
other health professionals.
 Medications, Medical Supplies, and Assistive Equipment
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Prices to be paid each year will be negotiated annually.
Formulary will promote the use of generics but allow the use of
brand-name and off-formulary medications.
Patients and Physicians will have the right to petition to have drugs
added to or removed from the formulary.
Administration
Secretary of
Health and
Human Services
Director of
Medicare for All
Program
Director of
Long-Term Care
Director of
Mental Health
Regional
Director
State Directors
Regional
Director
State Directors
Director of Office
of Quality
Regional
Director
State Directors
Regional
Director
State Directors
National Board of Universal Quality and Access
 To consist of 15 members appointed by the President
and approved by the Senate including:
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Health Care Professionals
Representatives of Institutional Providers of Health Care
Representatives of Health Care Advocacy Groups
Representatives of Labor Unions
Citizen Patient Advocates
National Board of Universal Quality and Access
 The Board will address the following Issues
 Access to Care
 Quality Improvements
 Efficiency of Administration
 Adequacy of Budget and Funding
 Appropriateness of Reimbursement Levels
 Capital Expenditure Needs
 Long-Term Care
 Mental Health and Substance Abuse Services
 Staffing Level and Working Conditions in Facilities
Confidential Electronic Patient Record System
 “The secretary shall create a standardized,
confidential electronic patient record system in
accordance with laws and regulations to maintain
accurate patient records and to simplify the billing
process, thereby reducing medical errors and
bureaucracy”
Take Home Points
It is logistically possible to create a single payer system
in the United States by expanding and improving our
existing Medicare system to cover all necessary medical
care for all residents of the United States.
2. HR 676 would create a more equitable and efficient
system, freeing physicians to focus on the needs of their
patients
3. HR 676 seeks to eliminate perverse profit incentives
within the current system that conflict with the needs
of physicians and patients.
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Questions/Comments?
HR 676 Full Text
 Full text of HR 676 is available through PNHP:
http://www.pnhp.org/sites/default/files/HR_676_2
013.pdf